Mastoiditis: Difference between revisions
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==Background== | ==Background== | ||
*Inflammation of middle ear spreads into mastoid air cells aditus ad antrum | *Inflammation of middle ear spreads into mastoid air cells via the aditus ad antrum | ||
**Can extend into cranial cavity and lead to brain abscess | **Can extend into cranial cavity and lead to brain abscess | ||
*Vast majority of acute mastoiditis occurs as a result of, or simultaneous with, acute otitis media | *Vast majority of acute mastoiditis occurs as a result of, or simultaneous with, acute otitis media | ||
**Mastoiditis is unlikely if middle ear examination is normal | **Mastoiditis is unlikely if middle ear examination is normal | ||
== | ==Clinical Features== | ||
*Abnormal TM findings | *Abnormal TM findings | ||
*Erythema, tenderness, | *Abnormal mastoid findings | ||
**Erythema, edema tenderness | |||
*Abnormal pinna findings | |||
**Protrusion of auricle, obliteration of postauricular crease | |||
*Cranial nerve VI and VII palsies | *Cranial nerve VI and VII palsies | ||
== | ==Diagnosis== | ||
* | *Middle ear fluid cultures | ||
*CT mastoid | *CT mastoid | ||
**Delineates extent of bony involvement | |||
==Treatment== | ==Treatment== | ||
*Abx | *IV Abx | ||
** | **Vancomycin + (ceftazidime OR cefepime OR piperacillin-tazobactam) | ||
==Disposition== | ==Disposition== | ||
Revision as of 04:18, 5 November 2011
Background
- Inflammation of middle ear spreads into mastoid air cells via the aditus ad antrum
- Can extend into cranial cavity and lead to brain abscess
- Vast majority of acute mastoiditis occurs as a result of, or simultaneous with, acute otitis media
- Mastoiditis is unlikely if middle ear examination is normal
Clinical Features
- Abnormal TM findings
- Abnormal mastoid findings
- Erythema, edema tenderness
- Abnormal pinna findings
- Protrusion of auricle, obliteration of postauricular crease
- Cranial nerve VI and VII palsies
Diagnosis
- Middle ear fluid cultures
- CT mastoid
- Delineates extent of bony involvement
Treatment
- IV Abx
- Vancomycin + (ceftazidime OR cefepime OR piperacillin-tazobactam)
Disposition
- Admit
Source
Tintinalli